ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of your bodies, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Another choice is allograft tissue, which is taken from a deceased donor.
Repair surgery is usually used primarily for cases where there is an avulsion fracture; this is separate of the ligament and a piece of the bone from the rest of the bone. In this case, the bone fragment t connected to the ACK is reattached to the bone.
ACL surgery is usually done by making small incisions in the knee and inserting instruments for surgery through theses incisions (arthroscopic surgery) In several cases; it is estimated by cutting a large incision in the knee during open surgery
Orthopedic surgeons do ACL operations.
Many orthopedic surgeons use arthroscopic surgery rather than an open surgery; which is cutting an incision in the knee, for ACL injury because:
It is easier to view and work on the knee structure.
Arthroscopic surgery uses smaller incisions than open surgery.
It can be completed at the same time as a diagnostic arthroscopy. Arthroscopy finds more about the damage was done to the knee.
There is few risk than open surgery.
Arthroscopic surgery is typically completed under regional anesthesia or general anesthesia
What Happens During Surgery
During Anthropic ACL reconstruction, your surgeon will make several small incisions- around two or three near the knee. The sterile saline(salt) solution will be pumped into the knee through one of the incisions to expand it and wash the blood from the area. This will allow the surgeon to see the structure of the knee more easily.
The doctor will insert an Arthroscope within one of the other incisions. A camera at the end of the arthroscope sends images from the inside of the knee to a Visual monitor in the operation room for the doctor to see.,
Surgical drills will be placed through other small incisions. The doctor drills small holes into the lower and upper leg bones where the bones are close to either a the knee joint. The holes will be for tunnels in which the graft will be anchored.
The graft is removed from the tendon at the front of the knee below the patella tendon or kneecap; which includes tow small pieces of bone called bone blocks on the ends of the time. One piece of bone is removed from the knee cap, and the other is removed from a part of the lower leg bone near the knee joint. This type of graft will allow the patient to heal better due the tendon being attached to its original bone, and the pieces of the bone just need to heal into their new placement.
If the autograft comes from the hamstring, bone blocks are removed. This type of graft can allow the knee to look more normal after it heals, due to the tendon from the front of the knees not being used. It may be easier to add additional tissue from a deceased donor called, an allograft to this particular type of graft.
The entire graft may also be removed from a deceased donor, allograft
The graft is drawn through the two holes that were drilled in the lower and upper legs bones. The surgeon secures the graft with tools such as staples and fasteners and will close incisions with tape or stitches. A managed is then placed on the knee, and you are moved to a recovery room for two to three hours.
What to Expect after ACL surgery
Arthroscopic surgery can be an arthroscopic surgery is typically an implemented as an outpatient procedure, meaning that you don’t have to stay overnight in the hospital. Other surgery may require you to stay in the hospital a few days.
You will likely be tired for several days. You knee will be swollen, and you will have numbness near the incision on your knee. You shin, and ankle may also be swollen and bruised. You can put ice on these areas to decrease swelling. Most of the swelling will activate in a few days; you should start seeing improvement in the knee soon after.
You should keep your incision clean and dry during the healing process, and watch for possible signs of infection
Physical rehabilitation after ACL surgery can take several months to a year. The amount of time until you can go back to performing your normal activities or sports is different for each; It can range from 4 to 6 months depending on the healing process.
Why Have an ACL Surgery
The priority of ACL surgery is to restore normal function, stability and health to the knee to the level or above before your knee injury, limit any loss in function to the knee, and prevent the degeneration and future injury to the knee structures.
Not every ACL tear needs surgery. Your doctor may recommend rehabilitation only or surgery and rehabs as an option for you.
You may choose to have ACL surgery if you have the following:
You have completely torn you ACL or have a partial tear in your knee is unstable.
You have gone through the previous rehab, and your knee is still not stable.
You are very active in sports, or you job requires you to have knee strength and stability, and you want as strong, stable knee as before in honey.
You are willing to undergo a long and rigor rehabilitation program
You have injured additional parts of the knee, such as the meniscus, knee ligaments, tendons or cartilage.
You have chronic ACL deficiency, which means your unstable knee affects your quality of life.
If you have a minor tear in your ACL, and it will heal with rest and rehabilitation.
You are not very active in your job or sport and does not require you to have a stable knee.
You are willing to stop doing actives that require a stable knee and higher levels of intensity; You may choose to substitute these activities with ones that do not require you to have a stable knee such as swimming and cycling
You can complete a rehab program that strengthens your leg muscles and stabilizes your knee as well as decrease the risk of you injuring your knee again, and you are willing to live with a minor amount of knee stability
You may not feel that you can complete a rigor and long reality program that will be necessary after surgery
You have other medical problems tat may make a surgery risky.
How well does surgery work?
There are a few people who will undergo ACL surgery yet still have knee pain and instability. They may need revision ACL reconstruction. Revision ACL reconstruction is usually not as successful as entail ACL reconstruction.
ACL surgery Risk
ACL reconstruction is safe in general. However, complications may occur from surgery or during rehabilitation and recovery
These uncommon problems, from the surgery itself, may be:
- Damage to the knee structure, blood vessels in the knee
- Blood clots in the leg
- Usual risk of anesthesia
- Numbness in the scar tissues from surgery
- Infection from surgical incisions.
- Challenges with graft tendons, which includes re-injury, loosening, stretching or scar tissues. The fasteners or screws that connect the grafts to the leg bones may cause problems and require removal.
- The limited range of motion, which happens at extremes, you may not be able to bend completely or strengthen your leg as far as the other leg. This is uncommon, and sometimes another surgery or manipulation under anesthesia can help. Rehabilitation tries to restore full range of motion, between 0 degrees(straight and 120 degrees flexion. It is crucial to be able to get your knee straight so that you can walk normally.
- Crepitus or grinding of the kneecap as it moves against the femur, also known as lower thigh bone, which may develop in individuals who did not have it before surgery. This can be painful and may limit one’s athletic ability. In rare cases, there can be a fracture while the graft is being removed during surgery or from fall into the knee following surgery.
- Kneeling may cause pain at the location where the tendon graft was removed in the patellar tendon, or the area of the lower leg bone, or tibia, where a patellar tendon or hamstring is connected.
There may be a repeat injury to the graft ( as the original ligament) Repat surgery are more complicated and less successful than the initial surgery.
In an avulsion fracture, getting repair surgery done as soon as possible is recommended.
IN reconstruction or partial or complete tears of the ACL, there is no best time for surgery. Surgery immediately after the injury has been associated with increased fibrous tissue leading to motion loss, or arthrofibrosis after surgery. Some researchers believe you should have del surgery until swelling declines, and you regain range of motion in your knee, and you can strongly flex the muscles in the font of you quadriceps. Many researchers recommend starting to exercise to gain range of motion and strength following shortly after the injury.
In adults age is not a consideration in surgery. Surgery may not be the best treatment for many people with medical conditions, who will be at risk. These individuals should decide to do nonsurgical treatments and may try to adjust their activities to protect their knees form additional injury.
Research done today, on ACL injury surgical treatment indicates different techniques and places to attach grafts, securing grafts, types of grafts, such as tendon, fascia grafts (autograft) muscles, and donor grafts (allograft). When deciding on the proper graft, you should think about the following.
- The success of a surgery likely depends on more the surgeon’s skill and preference than the type of graft used.
- A knee functions the same with either a hamstring graft or kneecap graft
- A kneecap tendon graft may result in pain when kneeling
- A kneecap graft entails more rehabilitation than a hamstring graft, with increased risk of pain and swelling, that may limit the range of motion and thigh much exercise for a period.